Neurological Emergencies in Patients Hospitalized With Nonneurological Illness

Abstract

Objective: We aimed to present neurological profiles and clinical outcomes of patients with acute neurological symptoms, which developed during hospitalization with nonneurological illness. Methods:We organized the neurological alert team (NAT), a neurological rapid response team, to manage in-hospital neurological emergencies. In this registry-based study, we analyzed the clinical profiles and outcomes of patients who were consulted to the NAT. We also compared the 3-month mortality of patients with acute neurological symptoms with that of patients without acute neurological symptoms.Results: Among the 85,507 adult patients, 591 (0.7%) activated the NAT.The most common reason for NAT activation was stroke symptoms (37.6%), followed by seizures (28.6%), and sudden unresponsiveness (24.0%). The most common diagnosis by the NAT neurologists was metabolic encephalopathy (45.5%), followed by ischemic stroke (21.2%) and seizures or status epilepticus (21.0%). Patients with NAT activation had high rates in mortality before hospital discharge (22.5%) and at 3 months (34.7%), transfer to intensive care units (39.6%), and length of hospital stay (43.1 ± 57.1 days). They also had high prevalence of poor functional status (78.1%) and recurrence of neurological symptoms at 3 months (27.2%). In a Cox proportional hazards model, patients with in-hospital neurological emergencies had a hazard ratio of 13.2 in terms of mortality at 3 months (95% confidence interval, 11.5-15.3; P < 0.001).Conclusions: Occurrence of acute neurological symptoms during hospital admission was associated with high rate of mortality and poor functional status. These results call for enhanced awareness and hospital-wide strategies for managing in-hospital neurological emergencies.

Newly developed stroke in patients admitted to non-neurological intensive care units

“…These findings underline the importance of early detection and proper management of stroke in patients admitted to the ICU with non-neurological critical illness. As most patients with IOS are taken care of by general physicians and intensivists who do not specialized in stroke management, the activation of stroke code and specialized teams may be needed for patients with stroke symptoms [27].…”

Characteristics and outcomes of medical emergency team calls in a Swiss tertiary centre – a retrospective observational study

“…Previous data show a vast variation of MET dose, ranging from 3 to 149/1000 hospitalisations depending on healthcare systems and regions [8,[22][23][24][25][26][27]. One reason for the variation in numbers might be the definition and role of the MET; in some hospitals, MET and resuscitation teams are the same team, and in other centres, such as ours, the MET is different from the resuscitation team, and therefore the MET dos not attend cardiac arrests.…”

Quantitative Assessments of Pupillary Light Reflexes in Hospital-Onset Unconsciousness

“…All data for the current study have been collected and documented on the registry of the Neurological Alert Team (NAT), a roundthe-clock neurologist-led rapid response team organized for the improvement of hospital-wide performance in response to in-patient medical emergency. [20] For this study, we included patients who were (1) 18 years of age or older, (2) admitted to non-neurological departments, and (3) activated the NAT due to hospital-onset unconscious state (ie, stupor or comatose state) as assessed by the ACDU (Alert, Confused, Drowsy, and Unresponsive) scale, which is a simple four-point scale for assessing patients presenting with altered mental status. [21] The NAT neurologists or clinical nurse specialists routinely measured the patients' pupils by using QP for initial neurological assessment during o ce hours.…”